title: Brain natriuretic peptide and cardiac resynchronization therapy in patients with mildly symptomatic heart failure.
abstract: BACKGROUND
  There are limited data on the prognostic implications of brain natriuretic peptide (BNP) assessment in patients with mildly symptomatic heart failure (HF) who receive cardiac resynchronization therapy with a defibrillator (CRT-D).
  
  
  RESULTS
  The effect of elevated baseline and 1-year BNP levels (dichotomized at the upper tertile BNP of 120 pg/mL) on the risk of HF or death was assessed among the cohort of 1197 patients with baseline BNP data enrolled in MADIT (Multicenter Automated Defibrillator Implantation Trial)-CRT. Elevated baseline BNP was associated with a significant 68% (P=0.007) and 58% (P=0.02) increase in the risk of HF or death among MADIT-CRT patients allocated to CRT-D and implantable cardioverter defibrillator-only therapy, respectively. At 1 year of follow-up, patients allocated to CRT-D displayed significantly greater reductions in BNP (26% reduction) levels compared with implantable cardioverter defibrillator-only patients (8% increase; P=0.005). Patients with CRT-D in whom 1-year BNP levels were reduced or remained low experienced a significantly lower risk of subsequent HF or death as compared with patients in whom 1-year BNP levels were high. Similarly, the echocardiographic response to CRT-D was highest among those who maintained low BNP levels or in whom BNP level at 1-year was reduced.
  
  
  CONCLUSIONS
  Our findings suggest that assessment of baseline and follow-up BNP provides important prognostic implications in patients with mildly symptomatic HF who receive CRT.
authors.affiliation: Division of Cardiology, and the Department of Biostatistics, University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brenyo
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
authors.forename: Mohan
authors.initials: M
authors.lastname: Rao
authors.forename: David T
authors.initials: DT
authors.lastname: Huang
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.forename: W Jackson
authors.initials: WJ
authors.lastname: Hall
authors.forename: Derick R
authors.initials: DR
authors.lastname: Peterson
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002170:Canada; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: cardiac resynchronization therapy; heart failure; natriuretic peptide, brain